1. Predictors of Outcome for Aortic Valve Reimplantation Including the Surgeon-A Single-Center Experience.
- Author
-
Tkebuchava S, Tasar R, Lehmann T, Faerber G, Diab M, Breuer M, Franke U, Kirov H, Gummert J, Lichtenberg A, Wahlers T, and Doenst T
- Subjects
- Adult, Aged, Aged, 80 and over, Aortic Dissection diagnostic imaging, Aortic Dissection mortality, Aortic Dissection physiopathology, Aortic Aneurysm diagnostic imaging, Aortic Aneurysm mortality, Aortic Aneurysm physiopathology, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency mortality, Aortic Valve Insufficiency physiopathology, Female, Germany, Hemodynamics, Hospital Mortality, Humans, Male, Middle Aged, Postoperative Complications mortality, Recovery of Function, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Young Adult, Aortic Dissection surgery, Aortic Aneurysm surgery, Aortic Valve surgery, Aortic Valve Insufficiency surgery, Cardiac Surgical Procedures adverse effects, Cardiac Surgical Procedures mortality, Replantation adverse effects, Replantation mortality
- Abstract
Introduction: Aortic valve reimplantation is considered technically demanding. We searched for predictors of long-term outcome including the surgeon as risk factor., Methods: We selected all aortic valve reimplantations performed in our department between December 1999 and January 2017 and obtained a complete follow-up. The main indications were combined aortic aneurysm plus aortic valve regurgitation (AR), 69% and aortic dissections (15%). In 14%, valves were bicuspid. Cusp repair was performed in 27% of patients. One-third received additional procedures (coronary artery bypass grafting, mitral, or arch surgery). We performed multivariable analyses for independent risk factors of short- and long-term outcomes, including "surgeon" as variable. Twelve different surgeons operated on 193 patients. We created three groups: surgeons A and B with 84 and 64 procedures, respectively, and surgeon C (10 surgeons for 45 patients)., Results: Cardiopulmonary bypass and clamp times were 176 ± 45 and 130 ± 24 minutes, respectively. In-hospital mortality was 2%. Postoperatively, 5% had mild and 0.5% had moderate AR. Kaplan-Meier's survival estimates, freedom from reoperation, and freedom from severe AR at 12 years were 97 ± 1, 93 ± 2, and 91 ± 3%, respectively. Age and chronic obstructive pulmonary disease appeared as risk factors for perioperative complications by univariate analysis. Age, coronary artery disease, and duration of cardiopulmonary bypass, but not surgeon, presented as risk factors by multivariable analysis., Conclusion: The results suggest that if a David procedure is performed successfully, long-term durability may be excellent. They also suggest that good and durable results are possible even with limited experience of the operating surgeon., Competing Interests: None declared., (Thieme. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF